Submitted:
27 October 2023
Posted:
31 October 2023
Read the latest preprint version here
Abstract
Background: Injury is an important cause of mortality and morbidity.(1). FA is the immediate assistance provided to a suddenly injured or sick person until professional help arrives or that person has recovered.(2), could be a potential factor differentiating between life and death in RTA . Many lives would be saved if proper first aid is provided early. (3) In the middle east, there are limited studies that explore knowledge and practices towards first aid needed during RTA. Objective: The main aim of this study is to investigate the knowledge and attitude towards first aid among drivers in Sharjah. Methodology: A cross-sectional study was conducted through a self-administered questionnaire written in Arabic and English languages. Participants were 18 years or older holding a driving license in the city of Sharjah. Paramedics and certified participants with a certification from authorized organizations were excluded . A non-proportional convenient sampling method was used. A total of 343 participants have completed the questionnaires. Data was entered and analysed using SPSS. Results: Majority of the study participants were less than 40 years old and (56.76%) were males. Most participants(94.2%) indicated that they know the term ‘First Aid’. However, (49.73%) of the participants knew the ambulance number and (52.43%) of the participants indicated that the victim should be moved to the hospital without the ambulance. With regards to attitude, 34.86% were not willing to provide first aid in the case of RTA. The main reason was lack of knowledge followed by fear of legal consequences. Most participants (83,78%) were willing to participate in first aid classes to improve their knowledge and attitude. Conclusion: Most participants are aware of the basic term of first aid; however, they are not willing to provide first aid in cases of RTA due to lack of knowledge and fear of legal consequences. Based on these findings we recommend providing first aid classes for new drivers and to obtain certification. References: 1 and 3. Midani, O., Tillawi, T., Saqer, A., Hammami, M., Taifour, H. and Mohammad, H., 2020. Knowledge And Attitude Toward First Aid: A Cross-Sectional Study In The United Arab Emirates. 2.Van de Velde S, Heselmans A, Roex A, Vandekerckhove P, Ramaekers D, Aertgeerts B. Effectiveness of nonresuscitative first aid training in laypersons:A systematic review. Ann Emerg Med 2009;54:447-57, 457e1-5.
Keywords:
first aid
; knowledge and attitude
; Sharjah
; RTA
Introduction
First aid plays an important role in minimizing the devastating consequences of road traffic accidents (RTA), which is a major global public health issue. Many people get injured or lose their lives due to RTAs on a day-to-day basis, which in turn, make RTAs one of the leading causes of mortality and morbidity worldwide and this highlights the importance of first aid, we cannot underestimate or minimize the value it provides.[1]
First aid serves as the first line of defense in saving people's lives, decreasing the rate of injuries, and providing instant care until the ambulance and the medical team help arrive. For example, a 2014 study done in Northern Iran, the study conducted on 500 drivers selected randomly from transport companies, the sample underwent first aid training courses and then evaluated after 0-3 months and 4-6 months. Improvement in giving first aid efficiency was observed also, the rate of correct interventions were higher after 4-6 months than 0-3 months. The study concluded that first aid programs designed for drivers were beneficial and enhancing in road traffic accidents as a prehospital care system. [4]
First aid is defined as prompt assistance given to someone who has become suddenly injured until professional help arrives or until the injured patient regains health. The main and primary goal of first aid is to save life, relieve pain, prevent further harm, or damage and facilitate quicker recovery. [1,2,3]
According to the World Health Organization (WHO), road traffic accidents (RTA) are responsible for approximately 50 million injuries and about 1.2 million deaths worldwide. Also, it is the 8th leading cause of disability-adjusted life years. [4,5]
In the UAE, many organizations, institutes and even universities provide teaching courses regarding basic life support (BLS) and first aid, and it’s usually limited to medical students and paramedics [1]. However, the important question is, what is the percentage of the population that knows the basics of first aid, and can they respond properly and effectively to life threatening accidents.
There are very few published articles and research that assesses first aid knowledge here in UAE, and even in the Middle east. As an illustration, a 2019 study conducted in UAE, found that approximately half of the population (54.2%) have limited understanding regarding first aid. And a mere (33.8%) had undergone first aid training courses. The ultimate findings of this study were that first aid knowledge here in UAE is lacking and insufficient. Also, the research suggests that first aid courses should be accessible to the general public and undergo frequent updates. [1]
Methods
Design of the Study
This cross-sectional study was executed in public spaces such as parks and malls within the emirate of Sharjah from October 2020 to November 2020.
Sample of the Study
The target population included people with a valid driving license and were available at the time and place of distributing the survey. Exclusion criteria consisted of people who did not speak Arabic or English, paramedics, and anyone with a basic life support certificate (BLS). A non-proportional convenience sampling technique was used. The sample size was calculated using the following formula n = 4p(1-p)/ME^2, where n = sample size, p = prevalence, and ME = marginal error. Prevalence was adapted from neighboring countries as not enough similar studies were conducted in the UAE. According to that, the sample size was found to be 385. Final sample size collected with regards to the exclusion criteria was 370.
Data Collection
A self-administered anonymous questionnaire was constructed based on a previous survey conducted in the UAE [1]. The questionnaire consisted of 18 questions divided into 3 parts: Demographics (6 questions), Knowledge about first aid (4 questions) and attitude towards first aid (8 questions). Data collection was carried out using a structured questionnaire. The questionnaire included sections on demographics, occupation, driving experience, first aid knowledge and awareness, emergency contact knowledge, first aid actions, breathing assessment, bleeding control, willingness to provide first aid, immediate responses to road traffic accidents, interest in first aid training, and opinions on the necessity of first aid training for all driving license holders.
For each individual a scoring system was calculated representative of overall knowledge score. The knowledge was assessed in both broad and specific manner. Three different scoring levels were used, a score 67% and above was labeled as ‘good knowledge’, and between 33% and 67% was labeled ‘moderate knowledge’, whereas any score below 33% indicated ‘poor knowledge’. [1]
Data Analysis
The data analysis for this study used the statistical software, SPSS 22 (Statistical Package for Social Sciences). Univariate analysis was conducted to gain an understanding of individual variables. Descriptive statistics including measures to conduct data such as frequency and relative frequency, measures of central tendency such as mean, median, and mode, and measures of variability. Inferential statistical tests including chi-square, t-test and Pearson correlation as appropriate to the type of variables involved were used. The level of significance was set to be at 0.05 ( P value).
Consent and Ethical Considerations
Ethical approval was provided by the medical research Committee of medical colleges, University of Sharjah under reference number REC-20-02-04-02-S. All participants were informed of the purpose of the study and their confidentiality was ensured. This study adhered to all ethical guidelines, including obtaining written informed consent from all subjects, questionnaires without signed consent were excluded from the study.
Results
Demographics and Basic Information
- 31.19
A total of 343 questionnaires were completed out of 370 distributed questionnaires. Hence, the response rate was 92.7%. The sample consisted of 195 males (56.76%) and 148 females (43.24%). Also, the most study participants were within the ages of (18-22) years (30.81%), participants over 40 years old were 26.22%, and 24.32% of the participants were within the ages of (23-29). whereas only a minimum number of participants were between (30-39) years old (18.65%). Based on the educational degree (39.19%) participants representing the majority have a bachelor’s degree followed by (33.785) participants attaining a high school diploma. Next, master’s degrees are the third highest educational degree obtained making it (11.08%). While college diploma makes it (1.54%) and the lowest education level in our questionnaire is primary school (1.08%). Regarding occupation, professional drivers/ health professionals representing 95 participants (27.6%) of the total participants were 248 participants (72.4%) were not professional drivers/health professionals.
Most of participants experience driving more than 4 years (57.84%), however, (48.38%) of the participants drive in an average (less than 2 hours per day), while 38.11% of the participants drove between (2 and 5 hours per day) And only a minority (13.51%) drive (more than 5 hours in a day) which usually represents the professional drivers work routine.
Knowledge about Basic FA Measures
The table (number of Table 1) summarizes knowledge scores across various demographics. When comparing knowledge scores across different age groups, the highest knowledge was observed among individuals aged 18-22, with 34% scoring as 'Good Knowledge' and 29.5% scoring as 'Moderate Knowledge.' On the other hand, individuals aged 30-39 demonstrated a lower knowledge score in basic first aid, with 38.9% falling into this category. A significant relationship was found between current job/occupation and knowledge in our sample (χ2=33.752, df=4, P<0.001). However, no significant differences were observed in knowledge based on gender, age group, educational degree, years of driving experience, or hours spent driving regarding basic first aid information in our sample.
Table 2.
Distribution of Performance Metrics Across Different Demographic, Educational, and Behavioral Categories with Statistical Significance Results.
Table 2.
Distribution of Performance Metrics Across Different Demographic, Educational, and Behavioral Categories with Statistical Significance Results.
| Performance | Poor | Moderate | Good | Pearson's Chi-Square | P-Value |
|---|---|---|---|---|---|
| Q2 Gender | |||||
| Male | 13 (72.2%) | 112 (58.9%) | 85 (52.5%) | =3.339, df=2 | .188 |
| Female | 5 (27.8%) | 78 (41.1%) | 77 (47.5%) | ||
| Age groups | |||||
| 18-22 | 3 (16.7%) | 56 (29.5%) | 55 (34.0%) | =8.870, df=6 | .181 |
| 23-29 | 6 (33.3%) | 46 (24.2%) | 38 (23.5%) | ||
| 30-39 | 7 (38.9%) | 33 (17.4%) | 29 (17.9%) | ||
| 40+ | 2 (11.1%) | 55 (28.9%) | 40 (24.7%) | ||
| Q3 What is the highest educational degree obtained? | |||||
| Primary school | 0 (0.0%) | 2 (1.1%) | 2 (1.2%) | =18.277, df=12 | .108 |
| Secondary school | 3 (16.7%) | 7 (3.7%) | 5 (3.1%) | ||
| High school diploma | 8 (44.4%) | 57 (30.0%) | 60 (37.0%) | ||
| College diploma | 3 (16.7%) | 25 (13.2%) | 11 (6.8%) | ||
| Bachelor's degree | 4 (22.2%) | 77 (40.5%) | 64 (39.5%) | ||
| Master’s degree and above | 0 (0.0%) | 21 (11.1%) | 20 (12.3%) | ||
| Others | 0 (0.0%) | 1 (0.5%) | 0 (0.0%) | ||
| Q4 Current work/occupation | |||||
| Professional Drivers | 6 (33.3%) | 14 (7.4%) | 2 (1.2%) | =33.752, df=4 | .000 |
| Health profession | 0 (0.0%) | 27 (14.2%) | 30 (18.5%) | ||
| Other | 12 (66.7%) | 149 (78.4%) | 130 (80.2%) | ||
| Q5 Years of experience of driving | |||||
| Less than 1 year | 2 (11.1%) | 23 (12.1%) | 23 (14.2%) | =2.289, df=4 | .683 |
| Between 1 and 4 years | 4 (22.2%) | 52 (27.4%) | 52 (32.1%) | ||
| More than 4 years | 12 (66.7%) | 115 (60.5%) | 87 (53.7%) | ||
| Q6 What is the approximate number of hours you spend driving per day? | |||||
| Less than 2 hours | 5 (27.8%) | 98 (51.6%) | 76 (46.9%) | =7.978, df=4 | .092 |
| between 2 and 5 hours | 7 (38.9%) | 70 (36.8%) | 64 (39.5%) | ||
| More than 5 hours | 6 (33.3%) | 22 (11.6%) | 22 (13.6%) |
df: Degrees of freedom; p-value<0.05.
Knowledge about Response in Life-Threatening Situations
knowledge:
Knowledge towards life-threatening situations in RTA is essential. Almost all of the participants (97.03%) agreed that calling for help is an attitude to perform in RTA. Majority of participants (87.84%) chose that we need to make sure that the victim is still breathing by checking chest movement (71.90%). Checking that the victim is conscious was the next common chosen correct answer (86.49%) by the participants.
Wrong answers were there, such as (52.43%) of the participants wanted to move the patient to the hospital from the accident site which caused further complications in the victim's life. In addition, nearly a quarter (23.8%) think that providing fluid is beneficial for the victim. Participants chose the wrong practice over the ‘I don’t know’ option which is not a safe attitude in RTA.
In road traffic accidents/ life-threatening situations, it is critical to know how to approach an injured human being. For instance, we assessed the participants’ knowledge regarding stopping heavy bleeding from a wound. We found out that 47.3% of our participants chose applying pressure on the wound, which is the correct option. Then the next common option was firmly wrapping a cloth above the wound where 38.7% chose that. Then came the minority of the participants (3.8%) and the remaining percent of answers (10.27%) chose “I don't know”.
Furthermore, we asked participants about their willingness to provide first aid in case of road traffic accidents. The answers were approximately distributed equally between yes (35.14%), no (34.86%) and uncertain (30.0%). To follow up the question, reasons for not having the well or being uncertain were mentioned. For instance, majority of people (62.45%) are not willing to provide due to “lack of knowledge” they don’t want to make the situation worse because they don’t have an idea about first aid. and (14.77%) of participants “fear of legal consequences” which is an illegal to participate first aid in the U.A.E without a certificate. (10.55%) because they feel nervous. While (9.28%) think that doing first aid is not their responsibility at all.
The initial response to witnessing a road traffic accident is a significant factor of assessment. The majority (61.35%) would respond to traffic accidents by “calling the ambulance” which is the correct practice, while (27.03%) want to call the police. ‘Do nothing’ (5.14%) wanted to not respond in case of a road traffic accident. (4.59%) wanted to provide first aid action. On the other side, (1.89%) wanted to transport the victim to the hospital.
Table 2.
Participants’ responses regarding knowledge of basic first aid knowledge.
| Correct Answers | Wrong Answers | |
| Have you ever heard about first aid? (Yes) | ||
| Ambulance number in UAE (998) | ||
| The priority first aid action that can be done to a victim of a road traffic accident. | ||
| a. Victims should be moved from the accident site (No) | ||
| b. Make sure that the victim is breathing properly (Yes) | ||
| c. Pour water on the victims to revive/refresh them (No) | ||
| d. Try to stop bleeding (Yes) | ||
| e. Try to give fluid to drink (No) | ||
| f. Transport victims to a hospital (No) | ||
| g. Call for help (Yes) | ||
| h. Check if the victim is conscious/ awake (Yes) | ||
Attitude of the Population toward FA
Participate in a free first aid course?
The majority (83.78%) are interested in attending a first aid course to gain knowledge and learn basic life support while only (16.22%) are not interested in attending a first aid course.
Last but not least, should all driving license holders be provided with first aid training? Almost eighty-six percent (85.95%) of participants agree that first aid should be provided along with a driving license to help prevent further injury, preserve life in case of car accident injury and only a small percentage disagree (14.05%) that first aid should be given with a driving license.
Table 3.
Participants’ responses regarding dealing with specific life-threatening situations.
| Correct Answers | Wrong Answers | |
| Appropriate method to stop heavy bleeding in the arm | ||
| Willingness to provide first aid in RTA | ||
| Willingness to participate in a First Aid course | ||
| First aid training should be provided to all driving license holders |
Discussion
In this study, we have assessed the knowledge and attitude of first aid among car drivers in Sharjah. Our results showed that almost all the participants (94.2%) indicated that they know what the term “first aid" means. However, almost one third (39.99%) did not know the correct ambulance number and almost half (52.43%) assumed that RTA victims could be transported to hospital without an ambulance.
A similar study conducted on in U.A.E on the general population showcased that almost half (54.2%) of the participants lacked sufficient knowledge about basic first aid.[1] With regards to attitude towards first aid, only one third of the participants indicated that they were willing to provide first aid to an RTA victim and the majority (83.78%) of participants were interested in attending first aid courses. These findings are consistent with a previous study done in Jordan. [6] Based on these results, we recommend providing first aid courses. especially targeting professional car drivers to equip them with the basic knowledge on how to react upon witnessing an RTA while waiting for the ambulance. As the study relies on self-reported information, this can cause recall bias. and respondents can also modify their answers on attitude and behaviors to meet the proper norms. Secondly, the study population was only in the Emirate of Sharjah and didn’t include the rest of the Emirates.
Obtaining a driving license can be done without the need for first aid training according to the Regulation and rules in the U.A.E of the Road and traffic authority (RTA), on the other hand, in countries as Austria and Switzerland, obtaining a first aid certificate or completing specific first aid courses and training is a requirement to obtain a driver's license. [7]
Changing the rules in the future is beneficial according to a study done in Egypt (Port Said) shows that, implementing a session about first aid to drivers in Port Said improved their knowledge. Before the session more than three fourths of the drivers had unsatisfactory knowledge about first aid and after completing all the sessions less than three quarters of them had satisfactory knowledge in all items of first aid. But the study showed that after 3 months of follow up knowledge dropped down due to forgetting. So not only implementing sessions and tests for drivers, but also follow up and revision of knowledge and practices is needed. [8]
According to the Heart Association's Emergency Cardiovascular care committee skills encourage review and practice at least every 6 months. At least annually for life-threatening emergencies and periodically for non-life threatening. [9]
Another study done in northern Iran also concluded that ‘The first aid training course for drivers is beneficial and helpful for the prehospital care system in road traffic accidents. In addition, it also showed that there is a drop in the fear of the participants in practicing first aid after obtaining a training course which will increase the quality of intervention in cases of road traffic accidents.
First aid training courses must be done by professionals because the quality of the course will differ in the outcome of the knowledge and practice. An Experience-based first-aid training 16 hours course focusing mainly on knowledge, skills, and the psychological setup in cases of road traffic accidents emergencies, showed better outcomes and remarkable differences in knowledge and skills of first aid of people who did normal first aid 4 hours courses.
To conclude that implementing a first aid course is beneficial but also, we don’t need to neglect the quality of the course itself. Adding a well-developed course about multiple aspects of first aid would be beneficial not only to the driver’s but also for the community itself. [10]
Limitation of the Study
In this study, we used a non-proportional convenience sampling method, our study was conducted in the city of Sharjah which limits the applicability of the findings among UAE.
Our target population were individuals above 18 years with a driving license which limits the generalizability of the study. There was no tool to refer or derive from in our questionnaire.
Some taxi drivers refused to participate in our study as they were busy with work. On the other hand, some participants of taxi drivers have language barriers as they do not read or speak English or Arabic.
Implications & Future Research
The results suggest that the majority of the participants are willing to acquire knowledge of first aid and obtain first aid certificates; however, they were not willing to provide first aid in cases of RTA due to lack of knowledge and fear of legal consequences. The result of our study suggests the need to implement first aid courses along with driving license learning procedures provided by Emirates Driving license Institute. Such recommendations can reduce the severity of disabilities and death rates when applied in the appropriate manner.
In the future, research should explore if introducing a mandatory First Aid (FA) course can boost both FA knowledge and people's willingness to offer assistance. It's also important to consider how the timing of taking an FA course could impact outcomes, requiring further examination. Lastly, future studies should assess how various courses handle real-life RTA."
References
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- El-Sharkasy, M.; Shenouda, M.; Enas El-Sheikh, I.; Naglaa Gida, I.; El-Shahat, M. Impact of First Aid Training Program for Car Drivers about Road Traffic Injuries in Port Said. Cairo Univ 2015, 83, 135–143. https://www.medicaljournalofcairouniversity.net/images/pdf/2015/December/20.pdf.
- Best Practices Guide: Fundamentals of a Workplace First-Aid Program. 2006. Available online: https://www.osha.gov/sites/default/files/publications/OSHA3317first-aid.pdf.
- Kureckova, V.; Vít Gabrhel Zamecnik, P.; Hobl, J. (2017, March). First aid as an important traffic safety factor – evaluation of the experience–based training. ResearchGate; Springer Nature. Available online: https://www.researchgate.net/publication/312324726_First_aid_as_an_important_traffic_safety_factor_-_evaluation_of_the_experience-based_training.
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